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Lapses seen at more sites

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Unsafe medical practices documented at a local medical clinic have occurred in other surgical centers throughout the state, recent surprise inspections at 13 locations by health officials found.

However, Nevadans are not being told which facilities were performing procedures that could put their health at risk, with officials saying that could interfere with an ongoing investigation.

The Review-Journal made repeated arguments to the state's Bureau of Licensure and Certification and the attorney general's office on Thursday asking that the names of the facilities be released as a matter of public safety. Those requests followed disclosure of the surprise visits at a Thursday morning meeting in Las Vegas of the Legislative Committee on Health Care.

State officials rebuffed the requests for information.

"What we're afraid of is that people will, once they see their name not out there, think they are in the clear,'' Linda Anderson, deputy attorney general for the Department of Health and Human Services, said after the meeting. "We still plan to do more surprise visits.''

The nearly three-hour meeting at the Sawyer Building was packed with members of the medical community and angry residents, there to hear lawmakers' concerns about the massive health alert that resulted in the closure of the Endoscopy Center of Southern Nevada on Shadow Lane as well as several other facilities operated by the same principals.

Last week, letters were sent to 40,000 people notifying them that they need to be tested for hepatitis and HIV, the virus that causes AIDS.

Other highlights of Thursday's meeting included:

• An announcement that five Certified Registered Nurse Anesthetists associated with the Shadow Lane clinic and its affiliates voluntarily surrendered their licenses.

• An announcement that the Shadow Lane facility submitted an incomplete patient list to investigators, meaning there may be more than 40,000 people who need testing.

• Recommendations by Dr. Lawrence Sands, chief of the Southern Nevada Health District, on how to avoid similar occurrences.

• An announcement by the state Insurance Commissioner that its office is approving requests by insurance carriers to waive patient co-pays for testing.

"We have a moral obligation to protect people,'' said Dr. Joe Hardy, R-Boulder City. "My duty as a physician is to do no harm.''

Lisa Jones, chief of the Bureau of Licensure and Certification, said the surprise inspections included one at Desert Shadow Endoscopy Center, a facility on Burnham Avenue near Flamingo Road that is owned by Dr. Dipak Desai. He is majority owner of the Shadow Lane facility, where it was found that reused syringes were tainting vials of anesthesia, infecting patients.

The 12 other ambulatory surgical centers -- outpatient facilities where patients don't require hospitalization -- inspected by the licensing bureau are not connected to a hepatitis C cluster.

"We're finding problems at various stages and various degrees. The problems include syringe reuse and medication vial reuse,'' Jones told the committee about the bureau's findings. "Sadly, this is not an isolated occurrence.''

Shocked by most of Jones' testimony, Assemblywoman Sheila Leslie, D-Reno, asked what help lawmakers could provide to the licensing bureau to help expedite the revocation and suspension of licenses when medical facilities engage in such "horrendous" and "off the chart" practices.

Jones, who has held her position since May, said the Bureau of Licensure and Certification didn't have the authority to pull the Shadow Lane clinic's license, because the deficiencies that were found were "immediately corrected."

Assembly Speaker Barbara Buckley, D-Las Vegas, said she believes there's enough evidence now for the licensing bureau to suspend or revoke the medical facility's license.

Reading from Nevada Revised Statutes, Buckley said this is doable if it's found there are violations of rules and standards; a facility is aiding or abetting an illegal act; or if patient safety is at risk.

"Seems to me we probably met all three,'' Buckley said. "In cases where you have a pattern of practices that are a conscious disregard for a patient's safety and well-being, you don't get a second chance.''

The center was fined $3,000 for its deficiencies. Buckley said that was too little.

She said the licensure bureau could have fined the facility up to $1,000 per day going back to March 2004, the date health officials established as the beginning benchmark for the health warning.

"What kind of message are you sending out to the entire community?'' Buckley said of the fine.

Hepatitis C attacks the liver, and only about 20 percent to 30 percent of people with the disease show symptoms, which include stomach pain, fatigue and jaundice of the skin.

Assemblywoman Susan Gerhardt, D-Henderson, said she and her husband underwent procedures at the Shadow Lane facility on separate dates in 2005. Neither received a letter from the health district urging them to get tested, she told the committee.

When the Gerhardts called the health district, they were told their names were not on the list of patients treated at the Shadow Lane facility between March 2004 and Jan. 11 of this year.

Brian Labus, senior epidemiologist for the health district, told the legislative committee that the agency received an incomplete patient list from the medical facility's management during its investigation, and that there probably are more patients the health district doesn't know about.

"We know of patients who had been there whose names were not on the list,'' he said.

Gerhardt, along with other legislators, were concerned that recent events might cause Nevadans to forgo tests for preventable diseases such as colon cancer.

She said physicians should be held responsible for what took place at the endoscopy center. But so far, only nurses have surrendered their licenses.

Debra Scott, executive director of the state's Board of Nursing, said the nurses, whom the board was investigating, were asked to do that voluntarily.

"When we do an investigation and we feel there is an immediate danger to the public, we have an opportunity to talk to the person or persons being complained against,'' Scott said. "Sometimes we say, 'In the best interest of public trust, we would really like you to voluntarily surrender your license.' That is what happened.''

Scott would not reveal the names of the nurses. But a Review-Journal inquiry led to the nursing board confirming three of the names. The nurses, who worked at various Gastroenterology Center of Nevada locations, were identified as Keith H. Mathahs, Ralph M. McDowell and Vincent G. Mione.

Also on Thursday, Gov. Jim Gibbons directed that all "available resources at the state's disposal" be used to complete the licensure bureau's inspections. There are 50 ambulatory surgery centers in Nevada.

Gibbons has authorized the use of the state Disaster Relief Fund, if necessary, to assist state health officials in their efforts.

He said in a statement that there is "the perception from the general public that it is not safe to have procedures done that help save lives, namely a colonoscopy exam."

The governor is expected to soon receive a letter from Dr. Vishvinder Sharma, who operates the Desert Shadow Endoscopy Center, resigning his position on the Nevada State Board of Health. Earlier this week, Sharma contacted the governor's office about the steps he needed to take to step down, said Dan Burns, a spokesman for the governor. The letter had not been received as of Thursday afternoon.

At Thursday's meeting, Dr. Lawrence Sands, chief of the Southern Nevada Health District, gave some recommendations to the committee to prevent such practices from occurring again.

Sands recommended that legislators take a hard look at how agencies regulate ambulatory surgical centers.

He also said Nevada might want to consider requiring that those centers be accredited by an agency such as the Joint Commission, which accredits hospitals.

Sands noted that health care professionals must be better trained in safety standards and ethics. On a more broader scale, he said, stakeholders should take a look at the entire health care system to ensure patient safety.

Leslie agreed. She called for an all-day special health care meeting with all stakeholders within the next 30 days.

"This is a public health emergency. I am disturbed by what I heard this morning,'' she said.

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